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CYE 15 Payment Reform Initiatives. Acute Care Continue CYE 14 model with 1% capitation withhold and the following changes: Minimum 10% of the value of total payments under all contracts with providers must be governed by shared-savings arrangements – NO sub-cap contracts counted

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Cye 15 payment reform initiatives
CYE 15 Payment Reform Initiatives

Acute Care

  • Continue CYE 14 model with 1% capitation withhold and the following changes:

  • Minimum 10% of the value of total payments under all contracts with providers must be governed by shared-savings arrangements – NO sub-cap contracts counted

  • AHCCCS considering limiting portion of shared savings with owner systems – 33% of total maximum?

  • AHCCCS considering adding geographic requirements – e.g. 80% maximum in any one GSA for multiple GSA plans?


Cye 15 payment reform initiatives1
CYE 15 Payment Reform Initiatives

ALTCS EPD

  • Implement initiative similar to Acute Care CYE 14 model:

  • Minimum 5% of the value of total payments under all contracts with providers must be governed by shared-savings arrangements – NO sub-cap contracts counted

    • Minimum 2% of total Acute Care service payments

    • Minimum 2% of total LTC service payments

    • Remaining 3% of total spend at MCO discretion


Cye 15 payment reform initiatives2
CYE 15 Payment Reform Initiatives

ALTCS EPD

  • Minimum 1.5% of Medicare DSNP total payments under all contracts with providers must be governed by shared-savings arrangements – NO sub-cap contracts counted

  • 1% capitation withhold

    • Distribution based on existing performance measures

    • Would prefer mix of Acute Care and LTC services

    • Input on performance measures welcome


Cye 15 payment reform initiatives3
CYE 15 Payment Reform Initiatives

ALTCS DDD

  • LTC Services

    • DES/DDD submit plan regarding value-based purchasing to AHCCCS by April 2015 for CYE 16 implementation

  • Acute Care Services

    • Implement initiative similar to Acute Care CYE 14 model:

  • Minimum 5% of the value of total payments under all contracts with providers must be governed by shared-savings arrangements – NO sub-cap contracts counted

  • Consider 1% capitation withhold

  • Input on performance measures welcome


Cye 15 payment reform initiatives4
CYE 15 Payment Reform Initiatives

CRS

  • Implement initiative similar to Acute Care CYE 14 model:

  • Minimum 5% of the value of total payments under all contracts with providers must be governed by shared-savings arrangements – NO sub-cap contracts/block purchasing counted

  • No capitation withhold due to single Contractor

  • Consider sanction for non-compliance


  • Cye 15 payment reform initiatives5
    CYE 15 Payment Reform Initiatives

    BHS

    • Implement initiative for integrated RBHA

      • Minimum 1% of the value of total payments under all contracts with providers must be governed by shared-savings arrangements – NO sub-cap contracts/block purchasing counted

      • No capitation withhold due to single Integrated RBHA

      • Consider sanction for non-compliance